5. MSK Flashcards
1
Q
What is kyphosis?
A
Abnormal posterior convexity of thoracic spine, causing a hunch back and back pain/stiffness.
2
Q
How can kyphosis be corrected?
A
With a brace if young.
3
Q
What is lordosis?
A
Abnormal posterior concavity of lumbar or cervical spine, causes a saddle back and back pain/stiffness.
4
Q
How can lordosis be corrected?
A
With a brace if young.
5
Q
What is scoliosis?
A
Abnormal three-dimesnional abnormality of the spine, with some lateral deviation, and potentially a degree of twisting.
6
Q
What can scoliosis lead to?
A
Issues with posture, and very rarely back pain.
7
Q
How can scoliosis be treated?
A
With bracing.
8
Q
What is a slipped disc?
A
Nucleus polposus herniates, and as a result leaks out from the centre of the intervertebral disk in either a postero-lateral or psoterior direction.
9
Q
What are the consequence of a slipped disc?
A
If in postero-lateral direction, pain. If posterior direction, paralysis from spinal cord compression in worst-case scenario.
10
Q
Which age is slipped disc more common in?
A
More likely as age increases as discs degenerate.
11
Q
What are the most likely levels for slipped discs?
A
L4-L5, or L5-S1.
12
Q
What causes whiplash?
A
Sudden jerking movement of the head.
13
Q
What is whiplash?
A
Sudden jerking of the head damages ligaments and muscles and can dislocate vertebrae.
14
Q
How does whiplash affect C5 and C6?
A
It causes them to adopt a sigmoid shape and causes C5 and C6 to hyperextend, moving them outside their range of movement and leaving them vulnerable to a dislocation.
15
Q
What are the results of whiplash?
A
Pain, and some partial paralysis if the spinal cord is damaged.
16
Q
Who are intracapsular fractures of the femur common in?
A
Older patients and women.
17
Q
What is the result of intracapsular fracture of the femur?
A
Medial femoral circumflex artery damaged so avascular necrosis of the femoral head.
18
Q
How does intracapsular fracture of the femur present?
A
Shortened and laterally rotated leg.
19
Q
How are intracapsular fractures dealt with?
A
Hip replacement.
20
Q
Who are extracapsular fractures of the femur common in?
A
Younger patients.
21
Q
How does an extracapsular fracture of the femur present?
A
Shortened and laterally rotated leg.
22
Q
What causes avulsion of the greater trochanter?
A
Huge force, like a car accident.
23
Q
What is the consequence of avulsion of the greater trochanter?
A
Attachment of gluteus medius and minimum means they can’t perform their function so positive Trendelenberg’s test.
24
Q
What causes mid shaft femur fracture?
A
Lots of force, car accident of crushing.
25
What are the consequences of mid shaft femur fracture?
Leg shortening from overriding of spiral fracture fragments, easily comminuted so takes a year to heal, risk of femoral artery damage.
26
What causes proximal fracture of the tibia?
Bumper car break in road traffic accident.
27
What is a complication of proximal tibia fracture?
Knee joint issues as cruciate and tibial collateral ligament attachment site damaged.
28
What causes stress fracture of the tibia?
Repetitive force on the tibia when the bone isn't strong enough.
29
What is the consequence of stress fracture of the tibia?
Tibia shortening from overlying of bone fragments.
30
What causes distal fracture of the tibia?
Overeversion of the ankle, forces talus against medial malleolus and fractures it.
31
What is a bimalleolar fracture?
Fracture of medial malleolus accompanied by lateral malleolus fracture.
32
What causes proximal fibula fracture?
Bumper break.
33
What is the risk of proximal fibula fracture?
Damage to common fibula nerve.
34
What causes distal fibula fracture?
Overinversion causing transverse fracture or excessive external rotation causing spiral fracture.
35
What causes talar neck fracture?
Excessiver dorsiflexion causes neck to snag on tibia and snap off, e.g. foot on break in road traffic accident.
36
What is a complication of talar neck fracture?
Disrupted blood supply to talus so avascular necrosis.
37
Why is there minimal displacement of fragments in talar fractures?
Malleoli hold everything together.
38
What causes talar body fracture?
Jumping from a height, the force is transmitted through calcaneus into talus.
39
What causes calcaneal fractures?
Falling from a particularly high heigh.
40
What are the consequences of calcaneal fractures?
Subtalar joint disrupted, joint becomes arthritic so inversion and eversion is difficult.
41
What can cause metatarsal fractures?
Dropping a heavy object on bones, stress fracture, excessive inversion.
42
What causes a femoral-radial pulse delay?
Aortic coarctation.
43
What signals ischaemic foot/leg?
Absent pulses of distal lower limb and popliteal.
44
What is deep vein thrombosis from?
Formation of a clot in a deep vein of the lower limb from hypercoagulability or stasis of blood.
45
What are the symptoms of DVT?
Pain, swelling, and tenderness distal to blockage.
46
What are the risks of DVT?
Clot embolising to the lungs.
47
How is pulmonary embolism from DVT prevented?
High risk patients are given heparin short term or warfarin long term.
48
What causes varicose veins?
Incompetence of the valves in the superficial leg veins. Backflow of blood causes vein distension and tortuous path.
49
What is the consequence of chronic valve disease in the superficial leg veins?
Increased venous pressure leading to bruising, brown pigmentation, and ulceration.
50
How is chronic valve disease in the superficial leg veins treated?
Repairing and reconstructing the valves, cut the veins or strip them.
51
What is a risk of stripping superficial leg veins?
Damage to the saphenous nerve.
52
Where is the femoral pulse felt?
The mid point between the ASIS and the pubic symphysis.
53
Why is the femoral artery being superficial clinically relevant?
It can be accessed for coronary angiograms and stents.
54
What is a femoral hernia?
Part of the bowel protrudes into the area.
55
What is a Baker's cyst?
Inflammation of the semimembranous bursa secondary to arthritis of the knee joint.
56
What is a popliteal aneurysm?
Dilation of the popliteal artery that compresses other structures in the popliteal fossa.
57
What can cause plexopathy of the lumbar and sacral plexuses?
Tumours/ space occupying lesions, diabetic amyotrophy, idiopathic plexopathy.
58
How is lumbosacral plexopathy treated?
Underlying factors are eliminated and steroids can help.
59
What is the presentation of femoral nerve damage at the hip?
Difficulty extending leg and flexing hip. Visible atrophy of quadirecps and desensitisation over cutaneous nerve distribution.
60
What is the presentation of saphenous nerve damage?
Pain and paraesthesia over posterior, anterior and medial leg, and medial edge of foot.
61
What is the presentation of obturator nerve damage at pelvis?
Weakened adduction, leading to posture and gait issues. Paraesthesia of medial anterior thigh.
62
What is the presentation of sciatic nerve damage in the gluteal region?
Loss of knee flexion, difficulty moving ankle and foot. Pain below knee except saphenous nerve innervation.
63
What is the presentation of tibial nerve damage in the posterior leg?
Loss of plantar flexion, flexion of toes, and weakened inversion of foot. Pain over cutaneous distribution.
64
What is the presentation of common fibular nerve damage at the neck of the fibula?
Loss of dorsiflexion so permanently planterflexed - foot drop. Gait issues and paraesthesia over posterolateral leg, dorsum of foot and skin between 1st and 2nd toes.
65
What is the presentation of entrapment of the superficial fibular nerve?
Pain and paraesthesia over cutaneous distribution.
66
What is the presentation of direct damage to the superficial fibular nerve?
Loss of eversion and paraesthesia over cutaneous distributions.
67
What is the presentation of deep fibular nerve damage in the anterior compartment?
Foot drop so abnormal gait. Pain over skin between 1st and 2nd digits.
68
What is the presentation of deep fibular nerve damage at the ankle?
Pain over skin between 1st and 2nd toes.
69
What causes the hip joint injury - slipped upper femoral epiphysis?
Minor trauma to the hip joint in a teenager, the epiphysis within the femoral neck slips.
70
What is the presentation of slipped upper femoral epiphysis?
Discomfort when walking or inability to work.
71
How is slipped upper femoral epiphysis treated?
Surgery and ban on walking as risk it'll slide far enough to constitute a femur fracture.
72
What is ischiogluteal bursitis from?
Excessive repetitive strain from sitting down too long.
73
How is ischiogluteal bursitis treated?
Rest and avoiding sitting down.
74
What causes trochanteric bursitits?
Excessive repetitive strain from running/exercise. Or in elderly from wear and tear - push on tendon and causes pain.
75
What is osteoarthritis of the hip?
Wear and tear of joint - cartilage is eroded so pain, and difficulty moving due to loss of articular surface, leaving bone on bone.
76
How is osteoarthritis of the hip treated?
With hip replacement, replace acetabulum with plastic cup and head of femur with metal prosthetic.
77
What is rheumatoid arthritis of the hip?
Inflammatory arthritis of the hip - inflammation of the synovium and fluid, then progresses to surrounding joint, ending in fibrosis and complete seizing of the joint.
78
How is rheumatoid arthritis of the hip dealt with?
Steroid alleviate it, hip replacement if very bad.
79
How is dislocation of the hip joint acquired?
From huge traumatic impact like knees on dashboard in high speed collision, causes femur to rip through ischiofemoral ligament and displaced posteriorly (weakest point of joint).
80
How common is congenital dislocation of the hip?
Fairly, 1.5 in 1000, boys 8 times as likely to be affected than girls.
81
What is congenital dislocation of the hip?
Abnormality of the acetabulum of pelvis or neck of femur so neonate is born with dislocated hip or it dislocates very easily.
82
What are the symptoms of congenital dislocation of the hip?
Inability to abduct at hip, medially rotated limb and positive Trendelenburg test.
83
What is medial collateral ligament damage to the knee caused by?
Blow to the lateral side of the knee, so the medial collateral is stretched in resistance and can tear, often tearing the medial meniscus with it.
84
What are the indicative symptoms of medial collateral ligament damage to the knee?
Pain on medial rotation.
85
What is lateral collateral ligament damage to the knee caused by?
Blow to the medial side of the knee so the lateral collateral is stretched and ruptured.
86
What is the indicative symptom of lateral collateral ligament damage to the knee?
Pain on lateral rotation.
87
What is ACL damage to the knee caused by?
Hyperextension of the knee joint, or force applied to a partly flexed knee.
88
How is ACL damage to the knee investigated?
Anterior drawer test - partially flex patient's knee and try to pul tibia anteriorly, if you can, then the ligament is torn.
89
What is the unhappy triad?
Tearing of the ACL leads to medial movement of the femur, which tears the medial collateral ligament at the same time, which rips the medial meniscus too.
90
What causes PCL damage to the knee?
RTAs often, flexed knee smash dashboard. Or from hyperflexion of the knee.
91
How is PCL damage to the knee investigated?
Posterior drawer test - partially flex the patient's knee and try to push the tibia posteriorly, if you can, then the ligament is torn.
92
What causes meniscal tear of the knee?
Commonly secondary/ tertiary to the unhappy triad, but can be caused by rapid rotation of the knee whilst the foot is planted on the ground.
93
What are the symptoms of meniscal tears in the knee?
Pain on extension and weight bearing.
94
How is meniscal tear of the knee investigated?
McMurray's test - click on external rotation whilst the leg is extended and supported on lateral side.
95
What causes dislocation of the patella?
Uncommon but from direct lateral/medial blow to knee or rapid twisting of the knee while the foot is planted.
96
How is dislocation of the patella dealt with?
Immediate relocation with enough force on patella.
97
What is prepatellar bursitis caused by?
Excessive repetitive strain - too much kneeling, housemaid's knee.
98
What is superficial infrapatellar bursitis caused by?
Excessive repetitive strain - too much kneeling, clergeymen's knee.
99
Which ankle ligaments are most often damaged?
Lateral ligaments as they are weaker.
100
What normally causes ankle ligament damage?
Excessive inversion causes lateral ligament damage.
101
What is Pott's fracture-dislocation?
Bimalleolar or trimalliolar fracture with displacement of the articular surfaces in the process. From excessive eversion, strains the medial ligaments so much that they avulse the medial malleolus. This causes the talus to move laterally and break the lateral malleolus. The distal tibia is forced anteriorly and the posterior aspect can be sheared off against talus.
102
What is pulled hamstring caused by?
Excessive stretch or tearing of the posterior thigh muscles from rapid movement, from a running or kicking sport usually.
103
What are the three severities of pulled hamstrings?
Grade 1 - muscle sprain.
Grade 2 - partial tear in hamstrings.
Grade 3 - complete rupture of one of the tendons/hamstring muscles.
104
What is the results of calcaneal tendon rupture?
Reduced ability to plantarflex.
105
What causes calcaneal tendon rupture?
Plantarflexion with limb extended, more likely with calcaneal tendonitis.
106
What is an antalgic gait?
Ongoing foot pain leads to an adapted gait where less time is spent in the stance phase of that limb's movement.
107
What is Trendelenburg gait due to?
Superior gluteal nerve damage so the gluteus medius and minimus are not supplied and can't stabilise the pelvis when one leg is off the floor so the pelvis drops.
108
What is the result on gait of Trendelenburg gait?
The leg swings down so the patient swings their trunk in the opposite direction in an attempt to correct their centre of gravity. Then they rapidly snap back in the other direction in a characteristic lurch.
109
What causes a high-steppage gait?
Damage to either the common or deep fibular nerve, causing foot drop so the toes will drag in swing stage. The patient counteracts this by raising their leg higher so the toes are clear off the floor. They may also evert their foot in eversion flick.
110
What are the key dermatome points to test in the lower limb?
```
L1 - hip/ upper anterior thigh.
L2 - mid anterior thigh.
L3 - anterior distal thigh (L3 above the knee).
L4 - mid medial leg.
L5 - mid lateral leg.
S1 - lateral plantar surface of foot.
S2 - posterior mid thigh.
S3 - outer buttocks.
S4 - mid buttocks.
S5 - inner buttocks/ anus.
```
111
What are the myotomes of the lower limb?
```
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - extension ofhallux
S1 - ankle plantarflexion
```
112
Where does the clavicle commonly fracture?
Between the medial 2/3 and lateral 1/3 point.
113
What fractures the clavicle?
Falling on an outstretched arm or a sports injury.
114
What happens to the fragments in a clavicle fracture?
The medial fragment is pulled up by the sternocleidomastoid muscle and the lateral fragment pulled down by the weight of the arm.
115
What are the four types of humeral frature?
Surgical neck, mid-shaft, supraepicondylar, and avulsion of the medial epicondyle.
116
What is the risk in fractures of the surgical neck of the humerus?
Axillary nerve damage and circumflex humeral artery damage.
117
What is the risk in fractures of the mid-shaft of the humerus?
Radial nerve and profunda brachii damage.
118
What is the risk in supraepicondylar fractures of the humerus?
Median nerve damage.
119
What is the risk in avulsion of the medial epicondyle of the humerus?
Ulnar nerve damage.
120
Why do the radius and ulna often fracture together?
The interosseous membrane and proximal and distal radio-ulnar joints mean if one breaks, so does the other normally.
121
What is a Colles fracture?
From falling on an outstretched hand, transverse fracture of the distal 2cm of the radius, ulnar styloid process avulsion and shift in ulna so it projects more distally. Dinner fork deformity from posterior displacement of the distal fragment.
122
Who are Colles fractures common in?
Menopausal women with osteoporosis.
123
What is a Smith's fracture?
Fall on flexed wrist so radius has transverse fracture of distal 2cm but there is anterior displacement of distal fragment, so opposite of dinner fork deformity.
124
What is a scaphoid fracture due to?
Fall onto palm of an abducted hand.
125
What is the complication with scaphoid fractures?
Blood supply is distal to proximal so the proximal fragment can be avascular and have avascular necrosis which can eventually lead to degenerative joint disease.
126
What is a key feature of a scaphoid fracture?
Pain over the anatomical snuffbox.
127
What is a boxer's fracture?
Break in the distal neck of the 4th or 5th metacarpal from punching an object.
128
What are the features of a boxer's fracture?
Tenderness over fracture site, minimal misalignment.
129
What are the nerve roots damaged in upper brachial plexus injury?
C5 and C6.
130
What are the nerves damaged in upper brachial plexus injury?
Musculocutanous and axillary nerves damaged.
131
What causes upper brachial plexus injury?
Large angle created between the shoulder and the neck like from a narrow birth canal or motorcycle crash.
132
What is the presentation of upper brachial plexus injury?
Waiter's tip/Erb's palsy - adducted due to loss of supraspinatus and deltoid (abductors), extended from loss of biceps brachii and brachialis (flexors), and medially rotated from loss of infraspinatus and teres minor (lateral rotators).
133
What are the nerve roots damaged in lower brachial plexus injury?
C8 and T1.
134
What are the muscles affected in lower brachial plexus injury?
Intrinsic hand muscles, FCU, medial half of FDP (ulnar nerve), other flexors of forearm (median nerve), total claw hand when trying to form a fist.
135
What is the presentation of lower brachial plexus injury?
Klumpke's palsy - total claw hand when trying to form a fist.
136
What causes lower brachial plexus injury?
Lower roots damaged from a sudden superior movement of the upper limb, e.g. grabbing a branch if falling from a tree.
137
What is a risk of axillary node clearance?
Winged scapula from damage to the long thoracic nerve that innervates the serratus anterior.
138
When do axillary lymph nodes become raised and tender?
From infection of the upper limb as this is where the lymphatic drainage goes.
139
What is an easy point in the arm for venepuncture?
In the roof of the cubital fossa - the median cubital vein runs along it.
140
Where are Korotkoff sounds heard when taking manual blood pressure?
The brachial artery where it is palpable in the cubital fossa.
141
What is handlebar palsy caused by?
Consistent pressure on the small Guyon's canal, i.e. from grasping bike handlebars, which leads to ulnar nerve entrapment.
142
What is the presentation of handlebar palsy?
Ulnar clawing, paraesthesia over palmar aspect of medial 1.5 digits (dorsal sparing from branch innervating dorsal skin before canal).
143
What causes carpal tunnel syndrome?
Median nerve becomes impinged against the rigid roof of the flexor retinaculum from a number of causes, TRAMPD - trauma, rheumatoid arthritis, acromegaly, myxoedema, pregnancy, diabetes.
144
What is the presentation of carpal tunnel syndrome?
Paraesthesia at the digital cutaneous branch of the median nerve (palmar sparing as palmar cutaneous branch arises before the carpal tunnel). There is atrophy of the thenar muscles if untreated. Worse pain at night as natural flexing puts pressure on canal.
145
How can carpal tunnel syndrome be tested for?
Tinel's sign - tap on nerve in carpal tunnel to elicit pain.
| Phalen's manouevre - hold wrist in forced flexion for 60 seconds to elicit pain.
146
How is carpal tunnel syndrome managed?
Splint used at night to hold hand in dorsiflexion to relieve pressure, treat underlying cause, corticosteroids, of carpal release as a last resort.
147
What can cause injury to the musculocutaneous nerve?
Stab wound to the axilla.
148
What is the presentation of musculocutaneous nerve damage?
Weak flexion at the elbow, weak supination at the elbow, lateral cutaneous nerve lost so desensitisation down lateral aspect of forearm.
149
What causes injury to the ulnar nerve?
At the elbow - fracture or avulsion of the medial epicondyle.
At the wrist - laceration of the wrist, e.g. self harm.
150
What is the presentation of ulnar nerve damage at the elbow?
Can't oppose FCR movement so flexion is accompanied by abduction, ab/adduction of fingers is impossible, unopposed extension at MCP joints and unopposed flexion at IP joints from 3rd/4th lumbrical paralysis so ulnar claw. No flexion at distal IP joints from medial FDP paralysis so ulnar paradox (more pronounced claw). Loss of sensitisation over palmar surface (dorsal sparing as dorsal innervation branches off before wrist).
151
How can the radial nerve be damaged?
At the axilla - dislocation, sustained pressure pushing into armpit (crutches), fractures of proximal humerus.
At humerus - mid shaft fracture of humerus.
At forearm/wrist - stabbing/laceration of anterior forearm.
152
What is the clinical presentation of radial nerve damage at the axilla?
Wrist drop, complete loss of sensation of cutaneous distribution of radial nerve.
153
What is the clinical presentation of radial nerve damage at the humerus?
Can't extend wrist or fingers, loss of sensation in posterior surface of lateral 3.5 digits.
154
What is the clinical presentation of radial nerve damage at the forearm/wrist?
Loss of sensation in posterior surface of lateral 3.5 digits.
155
How can the median nerve be damaged?
At the elbow - supraepicondylar fracture of humerus or incorrect venepuncture.
At the wrist - laceration just proximal to flexor retinaculum.
156
What is the clinical presentation of median nerve damage at the elbow?
Can't pronate arm, weak flexion with adduction, had of benediction, ape hand - loss of thenar muscles so can't oppose thumb. Pinch sign - can't make OK/perfect sign with hand.
157
What is the clinical presentation of median nerve damage at the wrist?
Hand of benediction, loss of sensation over cutaneous branches (palmar 3.5 digits), ape hand - can't oppose thumb.
158
How can the axillary nerve be damaged?
Dislocation of glenohumeral joint or fracture of surgical neck of humerus.
159
What is the presentation of axillary nerve damage?
Inability to abduct 15-90 degrees, palpable greater tubercle from deltoid atrophy and desensitisation of regimental patch.
160
What are the dislocations possible of the glenohumeral joint?
Dislocation likely when joint abducted to 90 degrees. Anterior from powerful adductors pulling humeral head anteriorly. Posterior uncommon but can be during epileptic fits or electrocution.
161
What is painful arc syndrome?
Subscapularis tendon is impinged under coracoacromial ligament so becomes inflammed and infected - subacromial burstitis. Pain between 50 and130 degrees of abduction.
162
What causes supraspinatus tear?
Ovreuse, sudden jerking, fall on outstretched arm, weakness from age-related degradation or impingement.
163
What is the presentation of supraspinatus tear?
Limited movement and acute pain. Abduction between 0 and 15 degrees impossible if ruptured so patient's use momentum of body to swing arm to 15 degrees where deltoid takes over.
164
What is subcutaneous bursitis?
Stress on olecranon causes inflammation of bursa so it swells and can cause infection.
165
How is subcutaneous bursitis managed?
Antibiotics to treat if infected, or leave to drain.
166
What is subtendinosus bursitis?
From repetitive flexion and extension of elbow joint so deep bursa swells outwards and become infected.
167
What is tennis elbow?
Lateral epicondylitis from repetitive extension of the wrist.
168
What is golfer's elbow?
Medial epicondylitis from repetitive flexion of wrist.
169
What is the cause of dislocation of the elbow joint?
Posterior - usual, from falling on flexed elbow so humerus goes anterior and radius and ulna posterior.
170
What is the presentation of elbow joint dislocation?
Ulnar nerve damage common, radial nerve damage possible but less common.
171
What is pulled elbow?
In children, injury of the proximal radio-ulnar joint from swinging the child by the hand. The radial head subluxates from the joint.
172
How is pulled elbow managed?
Manipulate radial head back into place, no real risk of neurovascular compromise.
173
What are the key dermatomes of the upper limb?
```
C5 - regimental patch.
C6 - tip of the thumb.
C7 - tip of the middle finger.
C8 - tip of the little finger.
T1 - middle medial anterior forearm.
T2 - tip of armpit.
```
174
What are the key myotomes of the upper limb?
```
C4 - shoulder elevation (shrugging)
C5 - shoulder abduction
C6 - elbow flexion/ wrist extension
C7 - elbow extension/ wrist flexion
C8 - finger flexion
T1 - finger abduction
```
